DEAR DR. DONOHUE: As a child I was diagnosed with a heart murmur. I am now 71. At age 62, I was told to have a chest X-ray because my physician heard a slightly unusual heart sound. Eventually I became a patient of a lung doctor who said I had pulmonary hypertension. Then I saw a new lung doctor who sent me to a medical center. A group of doctors was brought in and it turned out that the diagnosis is I have a hole in my heart and it has been there since birth. I had surgery to patch it up. Why don’t we hear more about this heart condition? – A.V.

ANSWER: I’m putting money on patent (PAY-tent) foramen ovale as being your diagnosis. It’s not uncommon and it is talked about a lot, but not so often outside medical circles. During fetal life, blood doesn’t go through the lungs. The mother provides oxygen to the fetus. Blood, therefore, goes directly from the right side of the heart to the left through a hole in the heart’s dividing wall. That hole is the foramen ovale, and it closes shortly after birth.

In a sizable number of people, it doesn’t close. It stays patent – open. If the hole is large, it can cause a drop in the oxygen level of the blood. It can also be a way for blood clots to find their way into the general circulation or into the brain’s circulation, where they cause a stroke. A large hole has to be closed.

Not when you were a child or even a young adult were there ultrasound machines. Now there are, and they give a good view of the heart and any holes it might have. For this particular problem, the ultrasound device is placed in the esophagus for the clearest view of the foramen ovale. That’s a transesophageal ultrasound.

I’m glad your heart odyssey ended on a happy note.

The booklet on valvular heart disease doesn’t deal with patent foramen ovale, but it does cover the many heart valve problems people have. To order a copy, write: Dr. Donohue – No. 105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My question is about fingernails and medical conditions. Why do some people have half moons on their nails and others don’t? – M.T.

ANSWER: If your question is what medical conditions cause nail changes, the answer would fill an entire book. Pits in the fingernails come with psoriasis. Iron deficiency can produce a spoonlike depression in the nail. White lines that traverse the nail from one side to the other indicate a temporary interruption in nail growth.

The half moon at the base (bottom) of the nail is called a lunula. Everyone has one. However, in some people, the cuticle – the fold of skin at the nail base – covers it.

DEAR DR. DONOHUE: I am 74, and for more than a year I have been treated for a rash that won’t go away. I insisted on a biopsy. It came back as being lichen sclerosus. My gynecologist prescribed clobetasol. I have not been able to go more than a few days without using the ointment. The rash goes, but returns.

What causes it? – C.H.

ANSWER: Lichen (LIKE-en) sclerosus (sklair-OH-suss) can appear at any age, but it mostly happens to postmenopausal women. Initially the outbreak consists of white, many sided, small, flat-surfaced and slightly elevated bumps. They’re surrounded with a red or violet halo. The rash can be maddeningly itchy. In time, the affected skin thins, wrinkles and becomes quite fragile. Genital skin is the target in most cases, but skin on the upper back, chest, thighs or breast can also be involved. Lichen sclerosus on genital skin infrequently becomes cancerous.

Its cause isn’t known, but a misfiring immune system appears to have a hand in it.

Clobetasol is standard medicine for it. It’s a powerful cortisone drug. Usually a person must use it daily for two or three months and then applications can be decreased to one or two times a week.

DEAR DR. DONOHUE: Help! Is there any over-the-counter stuff that keeps down blood pressure? I take a very expensive medicine and need badly to cut down on expenses. – M.S.

ANSWER: The expensive medicine you take is an effective drug, so keep with it, but ask your doctor if you could substitute a less costly one, like the diuretic HydroDIURIL. It’s only one-twentieth the cost of your medicine. It might not work, but there’s only one way to find out – try it.

Drugs are not the only way to treat high blood pressure. Go easy, very easy, on salt – sodium. Keep the daily sodium intake under 2,400 mg, the amount in a teaspoon. Preferably go lower – 1,600 mg. If you think you eat less than a teaspoon of sodium a day, think again. None of us comes close. Sodium is everywhere. Even if you lock up the saltshaker and avoid obviously salty foods, you eat lots of sodium. You have to read labels carefully.

Get five servings of fruits and vegetables every day. “Five servings” is not as outlandish as it sounds. A serving of vegetables is only half a cup of cooked or raw vegetables or a full cup of leafy vegetables. A fruit serving is a medium apple, pear or orange, a banana, half a cup of frozen or canned fruit, or 6 ounces of fruit juice.

Potassium brings blood pressure down. Foods with a high potassium content include baked potatoes with skin, oranges, orange juice, raisins, spinach, lima beans, bananas and cantaloupe.

If you are overweight, a modest weight loss lowers pressure. Exercise not only helps weight loss, but it reduces pressure in its own right. Thirty minutes of brisk walking every day suffices if your doctor says you’re up to that much exercise.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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